Healthcare Provider Details

I. General information

NPI: 1720548282
Provider Name (Legal Business Name): LAUREN ELIZABETH BUTLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E HIGHWAY 77
NEWBERN TN
38059-1169
US

IV. Provider business mailing address

100 E HIGHWAY 77
NEWBERN TN
38059-1169
US

V. Phone/Fax

Practice location:
  • Phone: 731-627-3553
  • Fax: 731-882-1256
Mailing address:
  • Phone: 731-627-3553
  • Fax: 731-882-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number176361
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26005
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: